MISSED OPPORTUNITIES IN PREVENTING COGNITIVE DECLINE: UNDERDIAGNOSIS OF POLYCYTHEMIA IN OLDER ADULTS

Abstract Polycythemia is a hematologic disorder characterized by an abnormally high red blood cell count which can result in serious complications. Microvascular clotting or emboli in polycythemia can reduce brain oxygenation levels with transient ischemic attacks or strokes and lead to subsequent development of vascular dementia. However, the impact of polycythemia on the brain health of older adults may be under-appreciated by primary care providers. The aim of this retrospective study was to investigate the prevalence of missed diagnoses of polycythemia in older adults with cognitive impairment. Electronic medical records (EMR) of patients with cognitive impairment, aged 60-100 years, inclusive of all races, ethnicities, and genders, seen between January 2018-January 2021, were obtained through the University of Arkansas for Medical Sciences database. Cognitive impairment included all subtypes of dementia and delirium with either primary or secondary polycythemia. A total of 9700 patients with cognitive impairment were analyzed for hemoglobin and hematocrit cut-off values for polycythemia. We found 696 instances of comorbid polycythemia of which only 88 (12.6%) had a correct polycythemia diagnosis on record. However, 608 instances (87.4%) had never been identified as having polycythemia either in the problem list or diagnosis. This study highlights the high prevalence of undiagnosed polycythemia in patients with delirium and dementia and underscores the importance of considering polycythemia as a potential etiology, when evaluating cognitive impairment. Early detection and appropriate management of polycythemia in older adults may have implications for reducing the incidence of vascular dementia and improving overall patient outcomes and quality of life.

United States,3. Advanced Science & Math Academy Charter School,Marlborough,Massachusetts,United States,4. Yale University,New Haven,Connecticut,United States,5. University of Massachusetts Amherst,Amherst,Massachusetts,United States,6. National Academy of Public Administration,Washington,District of Columbia,United States Reappraisal and mindfulness are associated with enhanced mood and emotion regulation.Cognitive control is key to both processes, and despite age-related declines in cognitive control, older adults report greater use of both compared to younger adults.The Dual mechanisms of control (DMC) framework posits that cognitive control can be engaged, either in anticipation of a task (proactive control) to enhance task performance, or in-the-moment (reactive control).In classic cognitive tasks, older adults show limited benefits from proactive control and intact reactive control, while mindful individuals show similar performance using both control modes.However, the role of trait mindfulness on proactive versus reactive control of reappraisal has never been explored across the lifespan.In this study, 41 younger (18-29) and 40 older adults (60-85) were cued to reappraise or view 80 negative images following a 4-s proactive or a 500-ms reactive delay, tracking pupil response as a measure of physiological arousal and effort.Multilevel models revealed that mindfulness was associated with greater proactive reappraisal benefits in younger adults.In contrast, mindfulness was associated with diminishing benefits of proactive versus reactive reappraisal in older adults; for low mindfulness, proactive benefits were found, and for high mindfulness, reactive control benefitted reappraisal more than proactive control (p < .001).For image viewing, proactive control benefitted older but not younger adults.Findings highlight the importance of considering the interaction of mindfulness and age in emotion regulation, and highlight the need of optimizing the temporal dynamics of reappraisal-based strategies in mental health interventions across the lifespan.

MIRROR-TCM TRIAL: THE INFLUENCE OF PATIENT-LEVEL FACTORS ON ACUTE CARE RESOURCE USE OF OLDER ADULTS
Onome Osokpo 1 , Karen Hirschman 1 , Monica Ahrens 2 , Wenyan Ji 2 , Alexandra Hanlon 2 , and Mary Naylor 1 , 1. University of Pennsylvania,Philadelphia,Pennsylvania,United States,2. Virginia Tech,Blacksburg,Virginia,United States Adverse Social Determinants of Health (SDoH) impact post-hospitalization outcomes (e.g., frequent acute care resource use: emergency department [ED] visits, rehospitalizations).The Transitional Care Model Intervention (TCM), an advanced practice registered nurseled team-based care-management strategy, has demonstrated improved outcomes among older adults throughout transitions from hospital to home.Yet, little is known about the relationship between specific patient-level factors (i.e., demographic, clinical, SDoH) and acute care resource use (i.e., counts of rehospitalizations and ED visits) among hospitalized older adults with multiple chronic conditions who receive the TCM intervention.A total of 480 patients were randomized to receive the TCM in the MIRROR-TCM trial conducted from September 2020 to March 2023 at three diverse health systems in four states.Using multivariable generalized linear mixed effects regression with backward elimination, we examined the relationship between demographic (e.g., biological sex), clinical (e.g., counts of chronic conditions, etc.), SDoH characteristics (e.g., transportation, etc.), and acute care resource use during the intervention.Compared to those without housing concerns, older adults with housing concerns had 2.4 times higher rates of ED visits (p=0.049) and 2.2 times higher rates of rehospitalizations (p=0.005).Those who lacked transportation for medical appointments had 2.5 times higher ED visit rates (p=0.021)and 1.5 times higher rehospitalization rates (p=0.041).For each additional comorbidity, the rate of rehospitalization increased by a multiple of 1.08 (p=0.008).Understanding the adverse SDoH factors and increasing clinical complexity impacting resource use and tailoring evidence-based transitional care interventions to mitigate these factors to improve posthospitalization outcomes is critical.
Polycythemia is a hematologic disorder characterized by an abnormally high red blood cell count which can result in serious complications.Microvascular clotting or emboli in polycythemia can reduce brain oxygenation levels with transient ischemic attacks or strokes and lead to subsequent development of vascular dementia.However, the impact of polycythemia on the brain health of older adults may be under-appreciated by primary care providers.The aim of this retrospective study was to investigate the prevalence of missed diagnoses of polycythemia in older adults with cognitive impairment.Electronic medical records (EMR) of patients with cognitive impairment, aged 60-100 years, inclusive of all races, ethnicities, and genders, seen between January 2018-January 2021, were obtained through the University of Arkansas for Medical Sciences database.
Cognitive impairment included all subtypes of dementia and delirium with either primary or secondary polycythemia.A total of 9700 patients with cognitive impairment were analyzed for hemoglobin and hematocrit cut-off values for polycythemia.We found 696 instances of comorbid polycythemia of which only 88 (12.6%) had a correct polycythemia diagnosis on record.However, 608 instances (87.4%) had never been identified as having polycythemia either in the problem list or diagnosis.This study highlights the high prevalence of undiagnosed polycythemia in patients with delirium and dementia and underscores the importance of considering polycythemia as a potential etiology, when evaluating cognitive impairment.Early detection and appropriate management of polycythemia in older adults may have implications for reducing the incidence of vascular dementia and improving overall patient outcomes and quality of life.

MISSING IN ACTION: STRATEGIES FOR DEMONSTRATING ORGANIZATIONAL COMMUNICATION IN NURSING HOMES Patsy Smith, and Julie Gordon, Fran and Earl Ziegler College of Nursing, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
A scoping review was conducted to learn more about strategic organizational communication within long-term care.Strategic organizational communication is a purposeful, system-wide, and system-level effort to transform the organization and delivery of care and services to make it easier to navigate, understand, and coordinate care.Care in nursing homes is complex and must consider residents' goals, values, and preferences.Communication strategies enacted at the system-level may include direct care staff, human resources, nursing-to-resident and family interactions, and care planning.Strategies at the institutional or system-wide level also include corporate stakeholders, administration, and employee leadership.The aim of the literature search was to locate evidence of communication strategies that reflect corporate and organizational goals, and that exemplify the processes by which communication influences administrative policy.Key words in the search were entered in varying iterations and combinations with the guidance of a skillful research librarian.Key words were long-term care, communication, feedback, nursing homes, patient-centered care, quality improvement.Returns were greater than 2,000, yet seemingly relevant abstracts were fewer than 300, and selected articles were fewer than 30.The research reports reviewed were explanatory or explorative and just one article was found to explore the role of communication strategies and the impact on organizational outcomes.Further, no research reports were found to discuss strategic organizational communication and a combination of resident and organizational outcomes.Rather, most work described specific communication interventions among key groups, many of which lacked sustainable impact.Study results, limitations, and examples of communication strategies are presented herein.Hip fractures sustained from falling are a devastating outcome for over 300,000 older adults every year in the US.The recovery from this major injury is extremally costly to the healthcare system and results in reduced mobility, increased dependency and up to 30% higher morbidity within 12 months of fracture.Avoidance of falls and injuries from falls is embedded into the standard of care for older adult providers though these standardized measures have not reduced the rate of death from falls as shown in recent studies.The study, Mitigation of Major Hip Injury due to fall in an At-Risk, Older Adult Population with a Wearable Smart Belt, seeks to compare the safety and efficacy of a wearable smartbelt to be worn around the waist of high risk older adults in order to mitigate major hip injuries related to falls through built-in sensors and the deployment of anatomically situated airbags around the hips during the hip impacting fall.The design of the study includes multiple older adult settings where subjects who are identified as being at high risk of fragility fracture and falls wear the study device for 6 months.Comparison of falls with major hip injury, emergency room visits and hospitalizations from falls and hip fractures from falls will be compared to a retrospective control group matched with the same inclusion/exclusion criteria.The poster will share the subject criteria and data gathered into November 2023.This study is listed on clinicaltrials.govNCT#05245097